scholarly journals Winged scapula following axillary thoracotomy with long thoracic nerve preservation

2020 ◽  
Vol 13 (2) ◽  
pp. e232970
Author(s):  
Tomomi Isono ◽  
Shigeshi Mori ◽  
Hidenori Kusumoto ◽  
Hiroyuki Shiono
Keyword(s):  
Rare Condition ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Nerve Preservation ◽  
Thoracic Nerve ◽  
Winged Scapula ◽  
The Right ◽  
A Site ◽  
Electric Scalpel ◽  
Fourth Intercostal Space

Winged scapula is a rare condition caused by injuries to the long thoracic nerve (LTN) and accessory nerves. A 69-year-old man underwent surgery for right lung cancer. Video-assisted thoracic surgery was converted to axillary thoracotomy at the fourth intercostal space. The latissimus dorsi was protected, and the serratus anterior was divided on the side anterior to the LTN. Two months after discharge, he presented with difficulty in elevating his right arm and protrusion of the scapula from his back. Active forward flexion of the right shoulder was limited to 110° and abduction to 130°. He was diagnosed with winged scapula. After 6 months of occupational therapy, the symptoms improved. The LTN may have been overstretched or damaged by the electric scalpel. We recommend an increased awareness of the LTN, and to divide the serratus anterior at a site as far as possible from the LTN to avoid postoperative winged scapula.

Surgical anatomy of the cervical and infraclavicular parts of the long thoracic nerve

2006 ◽  
Vol 104 (5) ◽  
pp. 792-795 ◽  
Author(s):  
R. Shane Tubbs ◽  
E. George Salter ◽  
James W. Custis ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Axillary Artery ◽  
Surgical Anatomy ◽  
Proximal Portion ◽  
Neurosurgical Procedures ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Scalene Muscle ◽  
Thoracic Nerve ◽  
Two Sides

Object There is insufficient information in the neurosurgical literature regarding the long thoracic nerve (LTN). Many neurosurgical procedures necessitate a thorough understanding of this nerve's anatomy, for example, brachial plexus exploration/repair, passes for ventriculoperitoneal shunt placement, pleural placement of a ventriculopleural shunt, and scalenotomy. In the present study the authors seek to elucidate further the surgical anatomy of this structure. Methods Eighteen cadaveric sides were dissected of the LTN, anatomical relationships were observed, and measurements were obtained between it and surrounding osseous landmarks. The LTN had a mean length of 27 ± 4.5 cm (mean ± standard deviation) and a mean diameter of 3 ± 2.5 mm. The distance from the angle of the mandible to the most proximal portion of the LTN was a mean of 6 ± 1.1 cm. The distance from this proximal portion of the LTN to the carotid tubercle was a mean of 3.3 ± 2 cm. The LTN was located a mean 2.8 cm posterior to the clavicle. In 61% of all sides the C-7 component of the LTN joined the C-5 and C-6 components of the LTN at the level of the second rib posterior to the axillary artery. In one right-sided specimen the C-5 component directly innervated the upper two digitations of the serratus anterior muscle rather than joining the C-6 and C-7 parts of this nerve. The LTN traveled posterior to the axillary vessels and trunks of the brachial plexus in all specimens. It lay between the middle and posterior scalene muscles in 56% of sides. In 11% of sides the C-5 and C-6 components of the LTN traveled through the middle scalene muscle and then combined with the C-7 contribution. In two sides, all contributions to the LTN were situated between the middle scalene muscle and brachial plexus and thus did not travel through any muscle. The C-7 contribution to the LTN was always located anterior to the middle scalene muscle. In all specimens the LTN was found within the axillary sheath superior to the clavicle. Distally, the LTN lay a mean of 15 ± 3.4 cm lateral to the jugular notch and a mean of 22 ± 4.2 cm lateral to the xiphoid process of the sternum. Conclusions The neurosurgeon should have knowledge of the topography of the LTN. The results of the present study will allow the surgeon to better localize this structure superior and inferior to the clavicle and decrease morbidity following invasive procedures.

scholarly journals Pectoralis Major Transfer for Treatment of Serratus Anterior Dysfunction in the Setting of Long Thoracic Nerve Palsy

2017 ◽  
Vol 6 (4) ◽  
pp. e1347-e1353
Author(s):  
George Sanchez ◽  
Márcio B. Ferrari ◽  
Anthony Sanchez ◽  
Nicholas I. Kennedy ◽  
Matthew T. Provencher
Keyword(s):  
Nerve Palsy ◽  
Pectoralis Major ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve ◽  
Pectoralis Major Transfer

scholarly journals Surgical and Clinical Decision Making in Isolated Long Thoracic Nerve Palsy

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 689-694 ◽  
Author(s):  
Shelley S. Noland ◽  
Emily M. Krauss ◽  
John M. Felder ◽  
Susan E. Mackinnon
Keyword(s):  
Decision Making ◽  
Nerve Stimulation ◽  
Nerve Palsy ◽  
Clinical Decision Making ◽  
Treatment Algorithm ◽  
Nerve Transfer ◽  
Clinical Decision ◽  
Serratus Anterior ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

Background: Isolated long thoracic nerve palsy results in scapular winging and destabilization. In this study, we review the surgical management of isolated long thoracic nerve palsy and suggest a surgical technique and treatment algorithm to simplify management. Methods: In total, 19 patients who required surgery for an isolated long thoracic nerve palsy were reviewed retrospectively. Preoperative demographics, electromyography (EMG), and physical examinations were reviewed. Intraoperative nerve stimulation, surgical decision making, and postoperative outcomes were reviewed. Results: In total, 19 patients with an average age of 32 were included in the study. All patients had an isolated long thoracic nerve palsy caused by either an injury (58%), Parsonage-Turner syndrome (32%), or shoulder surgery (10%); 18 patients (95%) underwent preoperative EMG; 10 with evidence of denervation (56%); and 13 patients had motor unit potentials in the serratus anterior (72%). The preoperative EMG did not correlate with intraoperative nerve stimulation in 13 patients (72%) and did correlate in 5 patients (28%); 3 patients had a nerve transfer (3 thoracodorsal to long thoracic at lateral chest, 1 pec to long thoracic at supraclavicular incision). In the 3 patients who had a nerve transfer, there was return of full forward flexion of the shoulder at an average of 2.5 months. Conclusions: A treatment algorithm based on intraoperative nerve stimulation will help guide surgeons in their clinical decision making in patients with isolated long thoracic nerve palsy. Intraoperative nerve stimulation is the gold standard in the management of isolated long thoracic nerve palsy.

scholarly journals Syndrome of fascial incarceration of the long thoracic nerve: winged scapula

2015 ◽  
Vol 50 (5) ◽  
pp. 573-577 ◽  
Author(s):  
Jefferson Braga Silva ◽  
Samanta Gerhardt ◽  
Ivan Pacheco
Keyword(s):  
Long Thoracic Nerve ◽  
Thoracic Nerve ◽  
Winged Scapula
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